 Okay, thank you everybody for being here. I think as you know in the last few hours we received confirmation of two presumed and I emphasize the word presumed positive cases of COVID-19 or coronavirus in Pennsylvania. Now I'm saying presumed positive for a reason because the results have to be confirmed by the CDC but we have two that we have tested in Pennsylvania and so we're presuming positive. One is in Delaware County and the other is in Wayne County. Both of the cases have been quarantined in their homes and as you also probably know the Bucks County five schools have been shut down by the superintendent and the health department there. So we're monitoring that situation in Bucks County. Our secretary of health Dr. Rachel Levine will give an update on all of this in just a minute. Since the identification of the COVID-19 or coronavirus has been again since the identification an emergency response team here in Pennsylvania right here in this building has been working diligently to develop a plan for when this virus inevitably arrived in Pennsylvania. The Department of Health set up an incident command center at the beginning of February so it's been up for five weeks now here in the Pennsylvania Emergency Management Building just down the hall and they have been coordinating and monitoring the responses that we've been making so I think they've been hard at work. There have been and will continue to be numerous daily briefings with the Federal Center for Disease Control and also the Department of Health is coordinating with other state agencies and other states and relevant federal agencies. State agencies that they're dealing with here in Pennsylvania include Pima of course the Departments of Human Services, Education, Military and Veterans Affairs, Agriculture, the Pennsylvania State Police, the Office of Administration, the Pennsylvania State System of Higher Education, the Department of Aging, and the list goes on and on. Right now the emphasis of the plan is mitigation tactics to keep this virus from spreading widely. The confirmation of these presumed again presumed positive cases should serve as a reminder of the role that every Pennsylvania must continue to play. This is a responsibility that goes to all almost 13 million of us in Pennsylvania. We have to control the spread of this disease by what we do day in, day out in our daily lives. So tactics like washing your hands for at least 20 seconds. Basically that's as long as it takes to sing happy birthday twice as a guide. 20 seconds covering your nose and mouth when you cough or sneeze and not with your hands but with your sleeve, your elbow. You can stop spreading the illness also just by not touching your face. So those things are important. If you feel ill, stay home. I'm encouraging employers to allow workers to take sick time. I'm also suggesting if you can offer telecommuting work and other options that allow employees to work without risk of sharing the disease. More information on prevention and the symptoms of the COVID-19 virus can be found by clicking the banner at the top of pa.gov. That's our website. We will continue to update that website as we gather more information. I want to emphasize that we all should remain calm here. Dr. Levine, our health secretary, has extensive background in medicine and she's leading the team of highly trained medical and public health personnel who are fully prepared to continue to do what they've been doing for the last five weeks and that is monitor the situation. So while the Department of Health is leading this response in conjunction with the Pennsylvania Emergency Management Agency, they're also coordinating with every level of government in Pennsylvania, the federal government, and beyond to tackle any issues that may come up. So I can assure you that our state government will continue to function smoothly as we respond to this public health issue and we're prepared to take action on secondary issues just as we do with natural disaster. So as the situation develops, we will continue to provide the public with information on the extent of the health crisis and our response. So again, please visit pa.gov and follow the banner link or follow the Commonwealth of Pennsylvania's official Facebook or Twitter pages. So now I'm going to turn this over to Dr. Rachel Levine, Secretary of Health for the Department of Health, Pennsylvania. Dr. Levine. Thank you, Governor. Good morning. Thank you for attending our latest update on the 2019 novel coronavirus or COVID-19. As Governor Wolf has said, we have two individuals with presumed positive cases of COVID-19. They are both at home. They are in isolation or quarantine. And at the same time, they are in good physical condition. We also are aware that five schools in Central Bucks School District have closed out of an abundance of caution. We are working with our partners at the Bucks County Health Department and School District. And at this time, however, there are no confirmed cases in Bucks County. And the situation there is actually not related to any Pennsylvania exposure. It is not related to the two cases that we're discussing. We are working with our county and municipal health department partners to continue to test individuals that meet criteria for testing for COVID-19. Importantly, we are able now, as we have been reporting all week, to do testing for COVID-19 at our state public health laboratory in Extend Pennsylvania. We are continuing to increase our testing capabilities at this state laboratory. And we are also aware that commercial labs are coming online to also begin testing. Our Pennsylvania response teams include our colleagues at PEMA, Pennsylvania Emergency Management Association, the Hospital and Health System Association of Pennsylvania, HAP, the Pennsylvania Medical Society, all of our courageous first responders, our county and municipal health department partners. And as the Governor mentioned, state, federal and local partners. And we are all prepared to deal with disease outbreaks, including this one. We expect more cases to be confirmed in the upcoming days and weeks. And we want everyone to take action to help prevent the spread of this novel coronavirus COVID-19. We will continue to update our website and have the latest information, tips and preparation checklists on our Department of Health website, health.pa.gov for you to use. Now, since the start of the flu season, we have encouraged Pennsylvanians to stop the spread of diseases by washing your hands, as the Governor said, for 20 seconds with warm water and soap. Happy birthday twice. Covering coughs and sneezes into your elbow. Cleaning surfaces. Not touching your face. Because if you touch a surface where there is a virus and you touch your face, that can theoretically lead to you're getting sick. And please, if you are sick, stay home. Those are the same healthy habits that we have been talking about all flu season. And people and families and individuals should continue to practice those to protect your family and yourself from the spread of this virus. As the situation evolves, we will continue to update Pennsylvanians through our website, our Facebook and Twitter account, and press conferences as necessary, such as this one. It is very important to remember that the most accurate and timely information regarding this outbreak is available through the Governor's website, through where you can click to ours, the Department of Health website, as well as the website for the CDC, which has very accurate information. If you have questions about your health, please contact your healthcare provider. We have been updating providers regularly on how to assess patients and with information about testing. What is most important for Pennsylvanians to remember is that we are prepared to respond to an incident just like this one. We have the networks in place, and we are ready to ensure that we can continue to work towards a healthy Pennsylvania for all. Thank you. Now, all of us would be happy to take questions. Yes. Yeah, I'm Dr. Boudine. Do you want to? Sure. So, you know, again, we are in full incident command, and we have been for for five weeks. And so our teams are in contact with hospitals with healthcare providers. And through that network, we became aware of these patients. They were assessed by their doctor, tests were performed, and then sent to or obtained, then sent to our laboratory, and then turned out to be positive. So at this time, you know, I think that you can understand for their confidence confidentiality, we're not discussing specifically how how they were exposed. And, you know, we don't want to say who they are, etc. Because that's according to our regulations, that's confidential information. Yes, sir. Were they traveling? Were they coming back from any of these countries? Or this is a community? So these were not community transmission or community spread in Pennsylvania. So it's important to remember what that means from a public health perspective. Community transmission means that they are that people can get sick. And they're tested for COVID-19. And we have no idea how they were exposed. These praise this is not community transmission. So it was through some travel. So they coming back from China or elsewhere? So we're not going through those exact details right now. But what we what happens now is that we will do contact tracing. So we know who these individuals are. We know their their history in terms of how they contracted the virus. And so we will now be going systematically through contacts and assessing those who've been in contact with these people doing appropriate testing. And then and then contacts will be quarantined for up to if they've had personal contact with this patient while they could have been sick, then they will be then they will be quarantined. So that's how this has gone in other states and how it will continue here. Dr. Watkins, is there anything else you'd like to add to that? Thank you. Dr. Sharon Watkins is our state epidemiologist. Ray Baraszanski here is, of course, our deputy secretary for public health prevention and community and community protection and response. And of course, you know, Randy Padfield, our director of PIMA and secretary of education here. Yes. Dr. Lee, there's been some talk about about the cost of a test, you know, people worried that they might get, you know, they might get hit with a big bill. You mentioned commercial labs, beginning the test. Like my question is, how does it stand right now? As far as getting tests? I mean, for one thing, could someone decide that they want to be tested or they need to be tested? Or how does it all play out? Sure. So this has evolved over the last five weeks, right, in terms of testing. So until Monday, when we first started testing at our laboratory, all the tests for COVID-19 essentially throughout the country were done by the CDC in Atlanta. And so if we had travel related cases that we were concerned about, our epidemiologists would call the staff at CDC have a robust discussion. And if they agreed, then we the sample would be obtained, which is essentially a nasal pharyngeal swab, and and then sent to CDC for for testing. So they controlled all of the testing. As you know, there had been challenges getting the test kits to the states and there had been issues with reagents. So that was worked out by the FDA and the CDC, essentially over the last weekend. And so last Friday and during the weekend. And so our labs came up for testing as other state laboratories on Monday. And we are increasing our ability to test really almost every day. So I'll get to your question. It takes it takes me a minute. So now what is happening since the testing is being done at our laboratory is that physician people who are concerned about they might have been exposed to COVID-19 would call our number 1877 PA health discuss it with our staff or they would call their doctor or hospital and then they would call us decide whether the person met the CDC criteria for testing and then we would obtain that testing. That's been a change now that the commercial laboratories will be available to test and that will where we'll be pleased to consult with all people and doctors but doctors will have the ability basically to assess and order a test. There is no cost for the testing at our state laboratory in Exton. We are covering that cost. And commercial laboratories I'm sure will be billing insurance we have discussed this extensively with the Department of Human Services and Medicaid as well as the Pennsylvania Insurance Department. If a person is in a situation where it comes to the attention of the doctor saying that they have likely symptoms and this warrants a test. Is it safe to say that that test is going to be paid for by the state? So if they obtain the specimen and they call us and they obtain the specimen and it goes to our laboratory that test is paid for by the state. Now that commercial laboratories are coming on board then that test if it's sent to one of the commercial laboratories then their insurance should cover Pennsylvania Medicaid or their commercial insurance or CHIP would cover the cost. We're working on what the issue will be for the small number of people smaller number than before in people in Pennsylvania who are uninsured. Now we are going to we're going to work to make sure that no one is denied a test that is medically necessary for COVID-19 because of the cost. Some of the concerns that I've heard described would be like people who maybe because of their deductibles or insurance status, the bill comes back to them. I think there have been some examples where people got maybe they even had insurance they were hit with a big bill. I'm trying to find out like what's the likelihood that that happened or what's the possible scenario. So we are aware of those reports and and actually even the report through the New York Times we reached out to that individual who was in Pennsylvania through our the Pennsylvania Insurance Department to link them to coverage. And so we will do everything we can to make sure that people are covered in terms of COVID-19. Again, we have had been in discussions with DHS in the Pennsylvania Insurance Department to work with our insurance companies on that. Governor, is there anything else you'd like to add? Dr. Lubin, Wayne County and Delaware County are our big places. Can you be more specific about where these people live? No, so we will not be more specific because we do not want to break their confidentiality. So we're not going to post a Google map and then say, oh, they live there, right? So I didn't ask for a Google map. No, we will not be releasing more detail. But we are tracking those patients' contacts as per all the CDC's guidelines and all public health guidelines. Sure. So if the patient, these two individuals, they will be quarantined at home and their close contacts will be quarantined at home as well. Dr. Watkins, do you want to expand about the home quarantine? Sure. We ask individuals to stay at home and to monitor their health. They are not to be going to work or to school or to go out in public or to use public conveyances. And then we work with them about social distancing from their family or anyone they need to interact with in the home. Is there a legal for them to go out? For these two patients, it would be illegal. We have a legal quarantine. It would be illegal to go out. Yes, sir. I think there was somebody who appeared. Yes. Just for general demographics, these two people, adults, elderly, children. So they are adults. We're not going into any more demographic detail, but they're not children. For perspective, I mean, how many people in Pennsylvania have been tested? So we're not going to have this specific number, but we have been following all of the guidelines from the CDC again until Monday, you can only test by calling the CDC and getting it approved. And so we are now continuing to follow the CDC guidelines. But now that we can control our testing, our expert staff is talking with physicians about liberalizing that so that we can make sure that we test all appropriate people in Pennsylvania. Yes. So we do not have any backlog of testing. So again, this is according to our regulations in terms of individuals' confidentiality has to do with our regs. So I know other states have identified a PUI, a person under investigation. We're really not identifying that. But we are telling you if it's positive. But it's a good point to point. We don't have a backlog. And we, the secretary and her team have been working diligently to make sure that there is plenty of capacity to do the testing that's required. So that was that's a central question. I know for the press, it's a central, central question for me. And also it's something that the command center and Dr. Levine have been taking very seriously. There's no backlog of tests early in the week. It was said that you were able to do six per day. What are you up to now? Sure. So again, we've been increasing our capacity every day. And so we can do 20 to 25 specimens per day today. And by the weekend, we'll be able to do 125 to 150 specimens. Again, assessments can also be sent to the CDC. So if there was any concern about a backlog, we could send the CDC. But now that commercial laboratories will be up and running, there will certainly no be no backlog of tests. In terms of a state of emergency, I know several other states have declared it. How close are you planning on declaring one? The governor will answer that. Yeah. As you know, Pennsylvania does not at this point have a health emergency declaration. So I will later this morning be signing a generic disaster declaration. The hope is that the legislature when they come back will actually give me the ability to do. I've been asking for this for some time to specifically call for a health emergency. But in the absence of that, I'll be declaring a disaster making a disaster declaration, we call it here in the next hour. So it sounds like you're saying that you would prefer to do the health declaration. Absolutely. What would be the main effect? The different. First of all, disaster declaration in Pennsylvania does not carry with it funding and things like that. But it gives us the ability to work across agencies and do things that we've done like with the opioid epidemic. In Pennsylvania, there's only one type of disaster declaration, and it's very broad. It's very generic. I've been calling for health disaster declaration ability so that I can focus on things having to do with public health emergency, which is what this is. So in the absence of that, a general declaration just simply gives me the ability to do a lot more things than I really need to do with the health declaration. It's fine. It accomplishes the same purpose. I'm trying to do this for the right reasons. It would just be, I think, a little more appropriate to have a health emergency declaration capacity. And yeah, that's not something they can do in a very short term. They'll give you that ability. They could. Could they? Yeah. They're coming back next two weeks, I guess. So you will ask. Oh, yeah. And I think I think there's a bill that's actually has been before the year or so ago. A bill passed the Senate got held up in the House. So there's there's legislation out there. But in the absence of that, I have the ability right now to declare a disaster declaration. I will do that. Anything else? There are two strains we now know of COVID-19. When we're testing, this might be more a question for Dr. Levine, but when we're testing, for that distinction, one is a lot more aggressive than the other. Thank you. Actually, I'm going to ask Dr. Watkins to answer that question. Hi, those those news reports are emerging and we have seen those. But in Pennsylvania, we are not testing for strains. And we can get you that information, whether CDC is at this time. So CDC may be testing. Maybe we can we can get that information for you. Okay, kind of unrelated question you mentioned earlier, the quarantines and how they are legally enforced. Are these people actually being monitored then by law enforcement? So so we're not monitoring with law enforcement. They're they're voluntarily quarantining, but that does have the force of law for these two individuals for these two patients. And so we'll be monitoring them pretty much daily by phone to make sure that they are that they're not getting sicker. If they're starting to get much ill, much more ill than we will arrange them to get the medical care that they need. Dr. Watkins, anything else about that? Voluntary quarantines and is it a voluntary quarantine or are they being compelled to be in their homes by force of law? So it's both, meaning if we needed to, we could compel them. But and they have received quarantine notices, but they're voluntarily staying. Is there anything else you'd like to add? Yeah, they have been directed to stay at home and they have complied. Yeah, but we know how hard it is to keep people. If they want to go to the corner store, the convenience store, can they do that? No. Yeah, because by the way, we saw, I think it was yesterday, I think it was from Pennsylvania, we saw the the directions to if you have to go out, if you must go out, you know, avoid crowds, don't use public transportation. It sounds like this is this goes beyond that. They're not supposed to go out. They are not. No. This is two people. Exactly. This is not a general directive. This is two people. Yes, they're quarantined. They don't go out. These individuals were known to have exposures. And so they've been quarantined, isolated and have followed those directions. So they were in a risk category that we had directed them not to go out. How do you know that they're following the quarantine? Well, we're in touch with them every day. We are relying on them to self report. So that's the standard from the CDC and when all other states are following. So I'm not aware of any state that is, you know, placing guards on anybody's houses. So this is the standard that has been followed since we've had our this United States has had his first case. And how long would their quarantine be for 14 days? We're not going to go into detail about the two specific patients, but all the quarantines are for 14 days. In terms of testing, how confident are you in your testing? I know there have been reports of some people testing negative twice and then the third time they're positive. Well, so we are very confident about our testing. I mean, we're following all of the CDC and FDA guidelines in terms of testing. We have a great public health laboratory, so we're very confident about the results. Two things, though, if someone is asymptomatic and they're negative, there's at least a five day incubation period until the symptoms might develop and they might start to turn positive. So that incubation period is about two to 14 days. And so if they, you know, if someone in another state had been tested and it was negative, it may that could have been part of the the incubation period and now it tests positive. Yes, I know probably gone over this before, but who are you most concerned that this will affect? And why is it so important to make sure that that you keep these people at a distance from COVID-19? Dr. Wilkins. Sure. I mean, we are still learning quite a bit about the disease, but we do know that those individuals who are elderly or have comorbidities, that would mean heart disease or asthma or COPD, are at increased risk of severity or death. Yes. Sure. So through our contact tracing, people who have had close contact with these individuals will then be quarantined and will be monitoring them and they'll be quarantined for 14 days if they had close contact according to the guidelines from the CDC. So that's how the contact tracing goes. It's kind of like a ring phenomenon and keeps kind of going out. Any of those folks who had contact with these two people? Well, we just had these results very, very, so we were, people are, our staff at the incident command center are working through those contact lists as we speak. Yes. Can I just give it to you? Yes, sir. Let me just say something. I think there's understandably a lot of focus on the legal aspects here. This is something people really want to do. They have a self-interest in preserving their health. And what I think the Department of Health is doing as departments of health have done in the past is to just indicate what people can do to ensure that the best possible outcomes. And in these two cases, quarantine is something that leads to that. And so the enforcement is not really something that is an issue. People really want to cooperate here. Yeah. I'm trying to imagine where it could be an issue. I think maybe somebody that really thought they really, really needed to go to work or they had some responsibility that would make them want to follow the guidelines of yesterday say where, okay, if you must. Yeah. I mean, I think you could probably come up with some example of somebody who might want to violate their own self-interest here. But again, I think the biggest thing working for all of us is that everybody wants to maintain their health. And what we're doing here with the Department of Health is trying to give them ways to do just that. I understand that their self-interest to their own health, but I'm thinking in terms of the risk to other people, like if they would choose, if they would just feel like they have to go out. I can't think of it. So yeah, I mean, if, if absolutely necessary, there is the force of law behind these quarantines, but, but today that certainly has not been necessary in Pennsylvania. And I'm not aware of any cases where that's been a big issue in the United States. You might be able to find a case, but not that we have been discussing regularly. Were these tests confirmed today? So the tests were done today and were positive. They're now being sent to the CDC for confirmation. So that's why we're saying a presumed test. The CDC guidelines is that all positive tests in the United States, the samples are then sent to the CDC for their lab to confirm it. I have not heard of any lab or any tests that though that have been positive in the States where the CDC has not confirmed it. And I may miss this detail about the quarantine, but are there at home quarantine, are they apart from their families? So what Dr. Watkins has said is that we ask them to practice social distancing and keeping a certain away apart, you know, certain number of feet apart from their families, but they're not separated from their families, but their families will need to be quarantined as well. Yes. So we're not really going over the specific information about these specific patients. But again, if you know, if people when people know them, they'll be able to track down who they are. And that's that violates their confidentiality in our regulations. Doctor, do you have any indication that these two people were in large crowded settings of people in the school building at a concert? Dr. Watkins. No, we are aware that one case traveled extensively in Europe and including to level three travel warning countries and did not move around in Pennsylvania upon return. We're also aware that one of the cases had exposure to a confirmed case in another state. And we became aware of that right away. And they've been in isolation or quarantine. So the exposure in Pennsylvania we are it's under investigation and but we think not at this time, but it's under investigation. Isn't that called community spread? If they get it from someone else in another state and then they or is that that's not. So what state where they are? We're not releasing those details. But it doesn't make I understand it doesn't make sense is in terms of using language. But the term community spread has a specific public health meaning and it doesn't meet that criteria. That would mean that someone pops up positive and they have no travel history. They have no known exposure and we have no idea how they got it. That has happened in California and Washington and I believe in Massachusetts. But but that's not what these cases are. So we have no known community spread in Pennsylvania. The way community spread is is defined by public health officials. What's here we are now that we know this. We're about to declare disaster emergency. What's going to be done differently today at hospitals with the MS providers with you know the people who are things aren't I mean well in terms of we'll be doing extensive contract contact tracing for these patients. So all of that is going to proceed. But the rest of our emergency preparedness is going to continue as it was. And we've been doing this for five weeks. And what Dr. Lavigne just said is the point we've been doing this for five weeks now and and there are really three prompts to this. One is to make sure that that that the Commonwealth Pennsylvania citizens know that we are monitoring this that we are daily less hourly look all the time looking at this. The Command Center has been up and running for five weeks now. So we are monitoring this. We're stockpiling the things and building up the capacity to do whatever we need to do. And the test is one of those things that you brought up. I think one of the concerns early on was that there was a limited capacity to test. We have been working assiduously on that. And I think we're doing the department has done a phenomenal job. And just the understanding that we will do what it takes to make sure the Pennsylvanians are safe. We've been doing that for five weeks. This is no different. We weren't sure. We didn't know when a case confirmed presumed for confirmed case would arise. But we were pretty sure it was going to happen. And it has. But we were ready for it and we'll continue to do what we've been doing. Just follow up on that. I know this is all costing money. How dependent are we on that piece of that federal funding that $8.3 billion that they're trying to get? That doesn't happen. We have funds internally that we've taken steps to make sure that we have resources here in Pennsylvania. That's how we've been able to get new equipment. That's how we've been able to to make sure that we're stockpiling the things we have to stockpile. We have the resources here. And if we get help from the federal government, that'll be great. Yes. Just going forward, if and when there are more presumed or confirmed cases, how will you be kind of releasing that information to the public so they know how to use it and how that works? We want to be transparent. That's why this happened this morning. I got a notification this morning at about 6.15, I think, and we are here a few hours later and we'll continue to make sure that we're as open and transparent as we can possibly be.